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Porcelain Gallbladder Or a Special Type Stone? a Case Report About Novel Gallbladder Disease

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Porcelain Gallbladder Or a Special Type Stone? a Case Report About Novel Gallbladder Disease Case Report Annals of Clinical Case Reports Published: 10 Jun, 2020 Porcelain Gallbladder or a Special Type Stone? A Case Report about Novel Gallbladder Disease Jinyu Pei1,2, Peng Liu1,2, Guanghua Cao1,2, Dongxia Yang1, Cong Wang1, Dongdong Dai1, Jingyu Cao1 and Linlin Qu1* 1Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qingdao University, China 2Medical College of Qingdao University, China Abstract Porcelain gallbladder is a mild and rare disease. Patients are usually asymptomatic and the diagnosis is often made incidentally on a plain abdominal CT scan. The CT scan was performed because the patient was abdominal pain after meal and the result was gallbladder neck stones and partial gallbladder wall calcification. Two days before the operation, the patient’s another abdominal CT scan showed that gallbladder wall is not calcified. The calcified gallbladder wall disappeared. Due to frequent episodes of abdominal pain, the patient underwent laparoscopic cholecystectomy. Postoperative specimens were found in the gallbladder neck stones and gallbladder mucosa attached to white jelly-like substances. The result of the abdominal CT scan was overturned: The porcelain white jelly-like substance attached to the gallbladder mucosa was not calcified by the gallbladder wall and may be the early manifestation of solid stones (semi-solid stones). Keywords: Porcelain gallbladder; Gallbladder stone; Calcified gallbladder wall; Cholecystitis Introduction Porcelain gallbladder refers to the gallbladder wall is formed into a hard, fragile and pale blue shape due to calcification. Cornell first reported and proposed the concept of "ceramic gallbladder" in 1959 [1]. The overall incidence of the disease is very low, about 0.06% to 0.80% [2,3]. A report on the suspected gallbladder wall porcelain in our hospital is as follows. OPEN ACCESS Case Presentation *Correspondence: A 60-year-old patient was hospitalized due to abdominal pain lasted more than two months in Linlin Qu, Department of the right upper quadrant after high fat diet. The patient had no jaundice, nausea, vomiting or fever Hepatopancreatobiliary Surgery, The and was physically healthy. Investigations revealed that he had no medical history of malignancy. Affiliated Hospital of Qingdao University, Physical examination was right upper quadrant tenderness, swollen gallbladder under the right Huangdao District, Qingdao, 266555, ribs margin and no tenderness in the lower back. Abdominal CT scan (1 month before operation, Shandong Province, China, Oct 16th, 2018) showed that the volume of gallbladder was reduced, the wall was thickened and E-mail: [email protected] calcified (Figure 1), and the circular calcareous density was observed in the neck region of the Received Date: 16 May 2020 gallbladder and there was a gallbladder stone with diameter 1.46 cm (Figure 1). But the patient’s Accepted Date: 08 Jun 2020 another abdominal CT scan (two days before the operation, Nov 23rd, 2018) showed that gallbladder Published Date: 10 Jun 2020 wall was not calcified (Figure 1) and there was a little bigger gallstone in the neck region of the gallbladder (diameter was 1.63 cm) (Figure 1). The clinical diagnosis was porcelain gallbladder Citation: with gallstones. Due to frequent episodes of abdominal pain, the laparoscopic cholecystectomy is Pei J, Liu P, Cao G, Yang D, Wang performed. During the operation, the doctor found that the gallbladder wall of the patient was hard C, Dai D. Porcelain Gallbladder or a and severely adhered to the surrounding tissues. In view of this situation, the patient's gallbladder Special Type Stone? A Case Report was completely removed after gradual separation of gallbladder wall and the surrounding adhesion about Novel Gallbladder Disease. Ann tissue. By observing the resected gallbladder, the gallbladder wall is thickened, the texture is soft Clin Case Rep. 2020; 5: 1847. and attached with sticky milky jelly-like substance, like plaster (Figure 2). The jelly-like substance is ISSN: 2474-1655 located in the gallbladder cavity and has a clear boundary with the gallbladder wall. Beyond that, a Copyright © 2020 Linlin Qu. This is an spherical stone can be observed on the neck of the gallbladder. Pathological examination after the open access article distributed under operation showed that the gallbladder mucosa was rough and attaches to white jelly-like substances, the Creative Commons Attribution no canceration. License, which permits unrestricted Discussion use, distribution, and reproduction in any medium, provided the original work Porcelain gallbladder is characterized by the gallbladder wall with a hard, fragile and pale is properly cited. blue special shape is a pathological change of cyst wall which caused by long-term inflammation Remedy Publications LLC., | http://anncaserep.com/ 1 2020 | Volume 5 | Article 1847 Linlin Qu, et al., Annals of Clinical Case Reports - Surgery Figure 2: A. The gross specimen of gallbladder after operation. It was attached with sticky milky jelly-like substance. B. the gallbladder mucosa was rough and attaches to white jelly-like substances. production [6]. Cholestasis and increased absorption of gallbladder may promote formation of gallstone, and gallbladder absorption increase the concentration of lithogenic factors in bile and facilitate nucleation and stone growth [7]. The patient's abdominal CT scan Figure 1: The CT scan of upper abdomen. A. the wall of gallbladder was performed a month ago shows that the gallbladder wall density thickened and calcified. B. the diameter of gallbladder stone was 1.46 cm. increases, and the abdominal CT scan gallbladder wall is not calcified C. the calcified wall of gallbladder was disappeared. D. the diameter of during surgery. However, the gallstone in the neck of the gallbladder gallbladder stone was 1.63 cm. is larger than before (The diameter of the gallstone changes from 1.46 cm to 1.63 cm.), and the components attached to the gallbladder recurrence and calcium deposition. Porcelain gallbladders are mucosa may be converted into stones. The cause and mechanism of associated with gallstones in 90% of cases. The patho-genesis of formation of semi-solid stones are still unknown. How to differentiate gallbladder calcification is still unclear and it is considered a result of the porcelain gallbladder and semi-solid stones in gallbladder before obstruction of cystic duct leading to the precipitation of calcium salts operation need further study. in the mucosa or as a result of chronic inflammation resulting in the Acknowledgement hemorrhage, scarring, and hyalinization of the wall causing deposition of calcium salts. The transformation of the gallbladder wall shown This work was supported by the National Basic Research Program from the patient's twice abdominal CT scans negates the diagnosis of (973 Program) in China (No. 2007CB513005 and 2009CB522405), porcelain gallbladder, but this phenomenon distinguished from the Shangdong Province Young and Middle-Aged Scientists Research porcelain gallbladder need further study. The main components of Awards Fund (BS2011YY004) and the Gut Barrier Foundation of Li gallstones are cholesterol, bile pigment, a small proportion of calcium Jieshou Academician. salts as well as mucin glycoproteins. Alterations in bile composition, References impaired gallbladder relaxation, and accelerated nucleation are the principal mechanisms leading to gallstones formation. According 1. Cornell CM, Clarke R. Vicarious calcification involving the gallbladder. to the main components of gallstones, it can be divided into two Ann Surg. 1959;149(2):267-72. major categories: Cholesterol stones and bile pigment stones. From 2. Opatrny L. Porcelain gallbladder. CMAJ. 2002;166(7):933. a worldwide perspective, 70% to 80% of gallstones are cholesterol 3. Shivanna Puttasubbappa P, Pallavi P. Porcelain gallbladder mimicking stones [4]. Traditionally, the formation of gallstones is explained as: carcinoma gallbladder-a case report and review of literature. Indian J Surg. The cholesterol in the bile is excessively secreted or too little micelles 2013;75(Suppl 1):208-9. caused by insufficient secretion of bile salts and lecithin is not enough to dissolve too much cholesterol, then supersaturated bile will form 4. Volzke H, Baumeister SE, Alte D, Hoffmann W, Schwahn C, Simon P, et al. Independent risk factors for gallstone formation in a region with high and cholesterol crystals precipitates to form cholesterol stones [5]. cholelithiasis prevalence. Digestion. 2005;71(2):97-105. The porcelain white jelly-like substance attached to the gallbladder mucosa may be the pre-existing performance of solid stones (semi- 5. Grebe A, Latz E. Cholesterol crystals and inflammation. Curr Rheumatol Rep. 2013;15(3):313. solid stones). The cause of the formation of semi-solid stones may be related to the absorption and secretion of the gallbladder mucosa, 6. Sayers C, Wyatt J, Soloway RD, Taylor DR, Stringer MD. Gallbladder absorption of the gallbladder mucosa can significantly increase the mucin production and calcium carbonate gallstones in children. Pediatr concentration of lipids, calcium and glycoproteins in the gallbladder. Surg Int. 2007;23(3):219-23. Gallbladder mucosa can also actively secrete mucus, which is made 7. Moser AJ, Abedin MZ, Giurgiu DI, Roslyn JJ. Octreotide promotes up of mucin and many glycoproteins, all of the above can promote gallbladder absorption in prairie dogs: a potential cause of gallstones. the formation of gallstones. Cystic duct obstruction promotes Gastroenterology. 1995;108(5):1547-55. calcium carbonate formation in bile and increases gallbladder mucin Remedy Publications LLC., | http://anncaserep.com/ 2 2020 | Volume 5 | Article 1847.
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